Prevalence of Undetected Genital Tract Premalignancy and Malignancy in Hong Kong Women Undergoing Hysterectomy for Uterine Prolapse

Abstract

Objective: To determine the prevalence of undetected genital tract malignancy and pre-malignancy in women who underwent hysterectomy for pelvic organ prolapse (POP).
Methods: This was a retrospective study of 497 women who underwent vaginal hysterectomy or laparoscopic-assisted vaginal hysterectomy for POP from 2005 to 2014 at a local hospital. The prevalence of malignancy and pre-malignancy was compared between pre-menopausal and post-menopausal patients as well as between those with symptoms of malignancy and those without.
Results: Of the 497 women studied, 415 (83.5%) were menopausal and only 67 (13.5%) had symptoms suggestive of malignancy. Two (0.5%) uterine malignancies, one (0.2%) cervical cancer, and one (0.2%) borderline ovarian tumour were detected in four asymptomatic patients, two of whom were menopausal. Twelve patients had pre-malignant conditions, including five cases of cervical intraepithelial neoplasia, six cases of endometrial hyperplasia, and one
case of vaginal intraepithelial neoplasia. Five of the patients were asymptomatic, and nine were menopausal. The overall risk of missed malignancy and pre-malignancy was 0.8% and 2.4%, respectively, in women who underwent hysterectomy for POP.
Conclusion: Routine histological examination of the hysterectomy specimens is recommended. Comprehensive preoperative examination is important especially in patients with symptoms suggestive of malignancy. Counselling of patients about the risks of missing malignancy is important in those who opt for uterus-preserving surgery.